Fluid-Management Strategies in Acute Lung Injury

To the Editor: The results of the Fluid and Catheter Treatment Trial (FACTT) conducted by the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network (June 15 issue) 1 support a conservative strategy of fluid management in patients with acute lung injury. This strategy should be recognized as only a step in the right direction. The furosemide dosing algorithm in the conservative-strategy group (range, 128 to 167 mg per 24 hours) simply resulted in an even — not negative — net fluid balance, which may have mitigated the potential magnitude of the benefit. Protocol-guided diuretic management, . . .